Aspirin may not be way to cut chance of a stroke
STROKE is a big problem in the UK – it’s the fourth most common cause of death, and a leading cause of major disability.
High blood pressure is recognised as one of the biggest single risk factors for stroke – which is why there have been so many campaigns highlighting the importance of watching our salt intake (since salt’s a big cause of hypertension) – but another possible risk factor is atrial fibrillation (AF).
The condition’s associated with a five-fold increased stroke risk. While it’s not the most common risk factor in stroke overall, figures suggest that every few hours, 10 people in the UK with AF will have a stroke, and strokes associated with AF tend to be major ones.
The good news is, modern treatments for managing AF can slash this risk. However, it seems lots of people still aren’t benefiting from the recommended treatments. To address this, a new campaign called AF180 Degrees – initiated by a number of experts and patient groups, including AF Association, AntiCoagulation Europe and the Arrhythmia Alliance – has just been launched, to ensure people with AF are fully aware of the associated stroke risk and what they can do about it. ble symptoms with your GP. The Arrhythmia Alliance (www.heartrhythmalliance.org) ‘Know Your Pulse’ campaign encourages people to learn how to take their own pulse for this purpose.
If AF is suspected, an ECG can be carried out to detect whether there’s an abnormal heart rhythm, and you might then be referred for further investigations.
“If your pulse is not regular, go and speak to your GP about it,” stresses Professor Martin Cowie, honorary consultant cardiologist at the Royal Brompton and Harefield NHS Foundation Trust, who adds that people should never ignore these symptoms, or assume they’ll take care of themselves. Of course, they don’t always indicate anything serious, but there are simple tests that can determine whether there is cause for concern.
“Often people are not taking palpitations seriously, or thinking, ‘Well, I had AF but it will probably settle’, so we’re downplaying it all the time,” says Prof Cowie.
HOW GREAT ARE THE RISKS? PROF Cowie points out that, while diet and lifestyle changes (being active, at a healthy weight, eating a balanced diet and not smoking or consuming too much alcohol) are known to help reduce the overall risk of suffering a stroke, for patients with AF, the AF-associated stroke risk can not be controlled by lifestyle changes alone, which is why it’s so vital that patients are aware of the link and are advised to take appropriate medication.
“AF strokes are caused by a clot in the heart, which breaks off, shoots up to the brain and blocks off a large section,” he explains.
“It’s usually a majorly debilitating stroke, and lots of [people who’ve had an AF-associated stroke] die within 30 days, and others are left very disabled because it’s so devastating.”
HOW CAN PATIENTS REDUCE STROKE RISK? NICE, the National Institute for Health and Care Excellence, issued new guidelines on managing AF two years ago, recommending modern anticoagulants (blood-thinning drugs), rather than simply aspirin (which used to be commonly prescribed), in order to slash the risk of AF-related stroke.
But Prof Cowie notes it’s still a “bit of a postcode lottery”, and it’s believed over 260,000 people with AF are not being treated in alignment with the new guidelines.
As he explains, there are probably a number of reasons for this. He notes that some patients may simply not have received advice about the new guidelines, some might not be fully aware of their increased risk of stroke, and some might be cautious of taking anticoagulants because of all the negative side-effects they’ve heard about (though he stresses that modern anticoagulants have come a long way and concerns based around side-effects should be discussed, rather than brushing the conversation under the carpet).
Others might still be taking aspirin as a sole treatment, though this is no longer recommended for AF stroke prevention.
He says patients who aren’t sure whether their AF is being managed in the best possible way should feel “confident” about having a conversation with their GP, and GPs should be “more pushy” in explaining things properly and ensuring patients have the full, up-to-date information.
There’s now a very simple scoring system doctors can do with patients that will give a straightforward assessment of somebody’s increased risk of stroke – which will then clearly demonstrate how much this risk will reduce with appropriate AF management.
“For the majority of cases, people with AF can reduce their stroke risk by about 70%,” Prof Cowie notes.
“The important thing is, GPs and patients need to be having these discussions.”
To find out more, visit www.af180.co.uk